Hearts and Minds: The Novick Cardiac Alliance and the Children of Ukraine

Memphis surgeon Dr. William Novick confronts poverty and war to save lives.

by

For the past three decades, the William Novick Global Cardiac Alliance has championed the expansion of pediatric cardiology in less-developed countries, both operating on children and training others to do so.

It was late 2021, and Dr. William Novick, professor of surgery and international child health at the University of Tennessee Health Science Center, was facing a dilemma. His colleagues in Ukraine had persuaded him to commit to four visits there in 2022, but lately the news from that part of the world had been troubling. And yet, because these visits were first discussed in 2019, then delayed by the pandemic, there was a sense of urgency in finally making them happen. What to do?

“We’d planned four trips, in March, June, September, and December of this year,” Novick told me when we spoke in May. “And then as the Russian troops started building up on the border, I started getting a little antsy. I asked my buddy in Kharkiv [Ukraine] what he thought, and he said, ‘Oh, it’s nothing! It’s Russian bluster! Putin’s trying to intimidate us. He’s not going to invade.’”

“Lviv was bombed while we were there, but we operated on six kids during that time. Three newborns, one 17 days old, one nine days old, and another who was eight days old. We did two infants who weren’t quite five months old yet, and there was a three-and-a-half-year-old toddler with heart disease, who was so bad off that if he walked more than about 50 steps, he would faint. So we operated on six kids, and everything was fine.” — Dr. William Novick

In keeping with Novick’s work with top-tier doctors and researchers, his Ukrainian buddy was none other than Dr. Igor Polivenok, chief of the Department of Interventional Cardiology and Cardiac Intensive Care at the V.T. Zaycev Institute of General and Urgent Surgery in Kharkiv — a man of informed opinion. As Novick explains, Polivenok was tasked with starting an interventional lab in the main hospital of Lviv, a city in far western Ukraine, and Novick was in turn recruited to develop the pediatric heart surgery program there. The two had collaborated for years; indeed, Polivenok was a co-founder of the William Novick Global Cardiac Alliance in 2014. They began working together in 1994, during Novick’s first visit to the Ukraine under the auspices of the International Children’s Heart Foundation, before Novick created the alliance that bears his name.

But on the matter of timing Novick’s visit, they didn’t quite see eye-to-eye.

“I’m watching the buildup get bigger and bigger,” Novick recalls, “and around January 2nd, I called the guys in Lviv and said, ‘I’m not happy with this. We’ve got this trip in March, and I’m really worried, so I’d like to move the trip back to late January or February.’ And they were still saying, ‘Aw, Bill, come on! Putin will never invade Ukraine! He’s not that crazy!’ I said, ‘Maybe he won’t, but I think we need to move the trip.’ So we went on January 22nd, for two weeks, and it was obvious to all of us that the Russian buildup was more than intimidation. But the Ukrainians just did not believe that Putin would do it.”

There are moments when one would rather not be correct. In the end, the foreigner’s assessment proved more accurate than the locals’. Novick began coaxing Polivenok to hedge his bets. “Igor works in Kharkiv, but he lives east of there in a gorgeous home, with a pond stocked with fish in the backyard, fruit trees, and an outdoor kitchen space,” he says. “On previous trips, we’d all visit, fishing and grilling and spending the whole day out there. But from his front door to the Russian border is only six miles. When we were in Lviv, he came over too, and I said to him, ‘Did you bring the wife and kids?’ He said ‘No.’ I said, ‘You need to get them out of Kharkiv!’ I worked on him for three days. And finally he said, ‘Okay, okay, we’ll tell the kids they’re coming on vacation to Lviv. I’ll rent an apartment for a month.’

As it turned out, Polivenok did just that, but he and his wife were back home in eastern Ukraine by February 24th. That morning, before dawn, they awoke to the sound of explosions, and as the sun rose, they looked out over their garden and pond to see Russian missiles sailing through the air towards Kharkiv. Throwing their dogs and a few essentials into the car, they left their home behind. By the next day, Russian troops occupied the village where it stood.

The threat of such experiences tends to hover over areas where Novick and his team carry out their mission of improving pediatric cardiological care. And in the midst of such turmoil, Novick is not only doing much of the surgery himself, he’s helping organize these programs logistically — gathering donated supplies, lining up financial contributions, and organizing training programs.

“We try to cover everything,” he says. “Obviously we do pediatric heart surgery, but we also train pediatric cardiologists to improve their diagnostic skills, or [work] on catheterization or anesthesia. And nurses in the ICU [Intensive Care Unit], respiratory therapists, the guys that run the heart-lung machine, and the cath lab technicians. We try to get all these people trained up. And we do a lot of it in conflict zones, so to speak.”

That includes places like Libya, Iraq, and Croatia. And though Ukraine was not a conflict zone when Novick began working there in 1994, it certainly is now. Yet, despite Novick’s misgivings about the developing threat of a Russian invasion there, once it happened, he was making a return trip in short order.

“We went back to Ukraine on March 13th,” Novick continues. “Lviv was bombed while we were there, but we operated on six kids during that time. Three newborns, one 17 days old, one nine days old, and another who was eight days old. We did two infants who weren’t quite five months old yet, and there was a three-and-a-half-year-old toddler with heart disease, who was so bad off that if he walked more than about 50 steps, he would faint. So we operated on six kids, and everything was fine.”

The team moved at a relentless pace. “It was a long haul to get there,” Novick says. They flew into Kraków on a Sunday, left there at 6:30 p.m., and their bus arrived at the Lviv Regional Children’s Hospital at 4 a.m. on Monday, along with supplies brought from the United States. “They put us up in the hospital — there’s no room anywhere in the city, in any hotel, because of all the refugees. So we took about a four-hour nap, I talked to the administrator, and we brought the first patient into the operating room at 4 in the afternoon. We made the first incision at 8 p.m. and finished at 3 a.m. on Tuesday morning.”

The non-stop work continued the following day.

“On Wednesday,” he says, “I went into the ICU to see a nine-day-old kid from Odessa who was intubated, on a ventilator, with two different medications to support his blood pressure, and very frightened parents sitting by the bedside. They were afraid he’d be brain-dead, because of the way he was when he arrived. So I looked in on the kid, and he’s moving everything, tracking people with his eyes. As I’m talking to the parents, I see the little boy reach out with his hand, grab his breathing tube, and try and pull it out. I turned to the parents and said, ‘You see this? I’m not sure your child has any brain damage.’ By then, his infection was gone, so we operated on him and he came back in good shape. Six days later, after we were long gone, they were seeing him as an outpatient. He was growing; the family was ecstatic.”

Such are the satisfactions of his work, but Novick remains driven by his awareness of how many children are still left behind in such countries. By way of example, he points to the situation in Angola, where his alliance plans to assist with the development of a cardio-pulmonary hospital.

Novick estimates that about 7,000 children are born with heart disease there every year, and roughly half of them will need some form of intervention to survive. As time passes, more and more of those who don’t receive surgery, catheterization, or other necessary treatments will die. Because there are only four pediatric cardiologists in all of Angola, only 10 percent of the original cohort needing medical attention will live to see their 18th birthdays.

In other locations where Novick’s Global Cardiac Alliance works, underdevelopment is the least of their problems. Sectarian conflicts within a country can cripple their medical work. “The easiest place to talk about this is probably Iraq,” he explains. “You’ve got these three different groups — Kurdish, Sunni, and Shia — and the only city where they get along is Baghdad. The only place we can operate on Kurdish kids is in the Kurdish area to the north. Otherwise, the Arabs won’t let us operate on them.

“If we’re in the northern part of the Shia area, we can operate occasionally on some Sunni kids. Maybe 30 percent. But if you move further south, you’re not going to see them. The pediatric cardiologists don’t even present them to us. All the kids we see are Shias. In Basra, nobody from outside the Basra province is going to be operated on. The Basra governor says, ‘We’re just taking care of our own.’ Meanwhile, there are thousands of kids in Iraq that need to be operated on, and we’ve only built up two programs so far. They need about ten.”

Novick doesn’t flinch at naming one cause of so much pediatric heart disease in Iraq: the United States. In particular, he singles out the U.S. military’s use of depleted uranium ammunition as a major contributor to congenital defects, including heart disease, in children born in and around Fallujah. “I’ve operated on kids from Fallujah in every city in Iraq where we’ve worked,” he says.

“In the middle of a freaking war, we were able to get this kid from the aggressor’s side, across the border, to the people that are being bombed, and operate on him and send him back home. He’s a special story, this kid. Misha’s now, I think, going to be in the third grade.” — Dr. William Novick

And yet, despite braving everything from missiles to sectarian infighting, Novick typically confronts an even greater obstacle: hospital bureaucracy. To battle that beast, he’ll even brave international conflicts, as he did when Russia first invaded Ukraine in 2014. In doing so for the sake of one child, he gained an understanding of the cultural differences between the two nations.

Working in the Russian city of Voronezh that year, Novick found his efforts to operate on one three-month-old child stymied by the hospital’s chief of cardiac surgery. Because there was a one-third chance the child could die, the official simply discharged the patient from the hospital. Higher mortality numbers would reflect poorly on his program.

Undaunted, Novick took matters into his own hands, calling his friend Polivenok in Ukraine. It mattered little to him that, with Russian troops having taken Crimea and most of Donbas and Luhansk, the two countries were at war. Using his connections in Ukraine, he obtained a special letter allowing the Russian child to cross the border, eventually operating on him successfully in Kharkiv. But he wasn’t done with the chief of cardiac surgery in Voronezh.

“I come to Veronezh two months later,” Novick recalls, “and I say to the staff, ‘I have a meeting later with the chief of cardiac surgery. Could you have the parents bring that child to the hospital for evaluation, and just happen to knock on the chief’s door, looking for me?’ ‘Oh sure, we can do that.’ So we set the son of a gun up, and the family comes walking in with the kid. He looks at the kid, looks at me, and I say, ‘Oh, this is the child you wouldn’t let me operate on six months ago. So just to make sure he lived, we took him to Ukraine for the operation.’ And you could see the fire coming out of this guy’s eyes, right? After the family left, he says to me, ‘You know, you are a real cowboy.’

“I said, ‘I don’t know about cowboy, but I know what I can do and I know what we’re capable of, and you didn’t think we could do it. And we took him to a far lesser hospital in far worse conditions, and here he is, back home, and in a year he’ll be ready for his last operation.’ In the middle of a freaking war, we were able to get this kid from the aggressor’s side, across the border, to the people that are being bombed, and operate on him and send him back home. He’s a special story, this kid. Misha’s now, I think, going to be in the third grade.”

Novick pauses to reflect on the two cultures. “What I’ve found,” he says, “is that the Ukrainians are far more hard-headed and stubborn than the Russians when you’re trying to break their standards that they’ve been doing for years, because it’s the wrong damn thing to do. The Russians were more accepting. But the Ukrainians are definitely far more compassionate.”

The contrast has a deep personal significance for Novick, whose Ukrainian grandmother and Russian grandfather escaped Soviet Russia to settle in Massachusetts. Indeed, when reflecting on his life for a 2009 profile in Memphis Downtowner magazine, he noted, “From my father, I got my Russian temperament, my tenacity, and my persistence.” And yet he inherited no small degree of compassion from his father as well. During his formative years in Montgomery, Alabama, his father was something of a ‘cowboy’ himself, in the name of civil rights.

“We had a Ku Klux Klan cross burned in our front yard because my dad employed all Black people at his dry-cleaning businesses,” he recalls. “One day I’m in the back of the shop, helping out, and I hear this yelling in the front. And it’s a Klansman, yelling at my dad. ‘You need to get rid of these N-word people! You need white folks working here, and we’re going to make sure that happens!’ And my dad said, ‘The only thing you can be sure of is you’re leaving this store.’

“And the next thing I hear is this crash. So I run up there, and there’s a guy on the sidewalk outside the store, and the window in front, saying ‘One-Hour Martinizing Dry Cleaners,’ has a big hole in it. My old man threw him right through the plate-glass window! And two nights later there was a cross burning in our front yard.”

Fortunately, that was the end of the matter. “Dad and the Alabama governor were drinking buddies! So not much happened after that cross burning.” The governor’s name? George Wallace Jr. The muse of history has a deep sense of irony.

That example stuck with the young Bill Novick, as did the life advice his father gave him. “I’m not exactly a small human,” Novick says. “I’m about 6’5” and weigh about 270. I was always big as a kid. But my dad taught me, ‘You never, ever intimidate anybody with your size. You protect people that are intimidated or bullied by other people. That’s your job. You’re big enough to do it.’ So that’s the way I was brought up: help those that are not able to help themselves.”

Those words motivate his work to this day. “I’m very passionate about it,” he says. “Unless you go to these places, I don’t think you can really grasp how desperate the situation is for these kids and their parents. My showing up, and their kid getting operated on — they truly consider it a miracle. I’m not trying to put us up there at all. Believe me, I’m very humble about what we do. But the parents: You’re in a country of 85 million people and there’s no heart surgery for kids, and your child is one of 18 that gets operated on? I mean, holy moly. There’s no way to look at that except, ‘God intervened — and made Novick operate on my child!’”